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General NPI Number Information
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NPI Number | 1740653526
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Entity Type | Organization
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Legal Business Name | MERIDIAN PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 4300 SW 13TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608
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Country | US
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Telephone | 352-374-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 SW 13TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608-4006
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Country | US
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Telephone | 352-374-5600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAUREN COHN
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Credential |
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Telephone | 352-363-0209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | HCC10982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | HCC10982
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License Number State | FL
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